MEDICARE: TASHA CISSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1811368970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TASHA CISSE

Provider Business Mailing Address
First Line	:	30 PERIMETER PARK DR STE 30
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30341-1334
Country	:	US
Telephone Number	:	678-278-5045
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 PERIMETER PARK DR STE 30
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30341-1334
Country	:	US
Telephone Number	:	678-278-5045
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2015
Last Update Date	:	10/15/2015

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Directions to “ TASHA CISSE ” Practice Location

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